Ricovir EM is a fixed dose combination two anti-retroviral medications i.e Tenofovir Disoproxil Fumarate & Emtricitabine. Ricovir EM is belongs to combination of two nucleoside reverse transcriptase inhibitor.
Ricovir EM is stops the reverse transcriptase enzyme that is required for viral proliferation. Ricovir EM is not a curable drugs, but it can reduce the disease breakthrough and inhibits the aggravation of HIV-1 infection into AIDS. Ricovir EM is a prescription medication which is used by the patient who is having a valid prescription with the guidance of medical practitioner.
Ricovir EM should be primarily indicated for the treatment of HIV 1 infection condition. Ricovir EM should be applicable for adults & pediatric patients with weight of at least 17kg. Ricovir EM is also indicated for the condition like HIV-1 pre exposure prophylaxis, this may used in concomitant with safer sex practices for prEP to diminish the exposure of sexually acquired HIV-1 infection in adults & pediatrics with weight of at least 35kg. Before starting the Ricovir EM treatment for PrEP condition, patient must be examine for negative HIV-1.
MECHANISM OF ACTION
Tenofovir DF is an acyclic nucleoside phosphonate diester analogue of adenosine monophosphate which is available as prodrug. Emtricitabine is a synthetic nucleoside analogue of cytidine Tenofovir DF experiences diester hydrolysis to shape as Tenofovir and further phosphorylation prompts deliver tenofovir diphosphate. This diphosphate type of tenofovir is denies the movement of HIV-1 RT by battling with deoxyadenosine 5' triphosphate (regular substrate). This may embed into viral DNA causes chain disposal. Emtricitabine undergoes phosphorylation with the help of cellular enzymes to form an active moiety called as Emtricitabine 5’ triphosphate which is responsible for prohibition of HIV-1 RT. This inhibition occurs by fighting active moiety to natural substrate like deoxycytidine 5’ triphosphate get intervened into DNA and causes chain elimination.
After absorption of Ricovir EM , reaches maximum plasma concentration time are; Emtricitabine: 1 to 2 hours; tenofovir DF: 1.0 plus or minus 0.4 hour. The oral bioavailability of tenofovir is occurs by 25%, by administering with food, bioavailability reaches by 40%.
Tenofovir has low binding capacity, <0.7% to human plasma proteins & <7.2% to serum proteins. Emtricitabine has low protein binding capacity by less than 4%.
The metabolism of Tenofovir DF not induced by cytochrome isoenzymes The metabolism of Emtricitabine is induced by undergoing biotransformation.
The elimination of Ricovir EM is occurs through glomerular filteration & active tubular secretion. The half lives of Ricovir EM is Tenofovir DF: 17 hours with range of 12.0 to 25.7 hours. Emtricitabine: 10 hours with range of 7.4 to 18.0 hours
DOSAGE & ADMINISTRATION OF TENVIR EM
- Before begin the treatment using with Ricovir EM , patient should be examine thoroughly for presence of HBV infection or not. Hepatic function test & renal function test should be monitored. 2. Patients receiving Ricovir EM for PrEP, screening the HIV-1 infection for once three months.
The advised dose of Ricovir EM for adults & pediatric with weight of at least 35kg is one tablet should be administered as once daily by taking with food or without food.
FOR PREP CONDITION
One Ricovir EM tablet should be taken as once daily for both adults & pediatric with weight of at least 35kg.
DOSAGE ADJUSTMENT FOR RENAL IMPAIRED PATIENTS
CrCl ≥50ml/min, one tablet should be taken for every 24 hours CrCl 30 to 49ml/min, one Ricovir EM tablet should be taken for every 48 hours CrCl <30ml/min, Ricovir EM tablet should not be recommended
WARNING & PRECAUTION
LACTIC ACIDOSIS & HEPATIC STEATOSIS
This fatal condition is occurs due to increased hepatic enzymes. To prevent this condition by monitoring the hepatic functions & hepatic enzymes levels. In severe condition, Ricovir EM should be stopped.
DUE TO DRUG INTERACTIONS
Some combinational therapy leads to cause severe adverse effects. Ricovir EM should not be combined with Trustiva, Atripla, or Viraday.
HIV-1 & HBV CO INFECTION
Due to exposure of advancement of HIV-1 resistance, Ricovir EM should be used in patients who are co infected with HIV-1 HBV by combining with other anti-retroviral drugs. Before initiating the treatment, patient should examined by testing the HIV-1 antibody
AGGRAVATION OF HBV INFECTION
This severe fatal case is occurs, after conclusion of anti-hepatitis B treatment. To prevent this effect by monitoring the patient’s hepatic functions before begin the therapy. In final condition, patient should be resuming with anti-HBV therapy.
The major risk of Ricovir EM is loss of bone mineral density. To overcome the problem by providing the vitamin D supplements.
NEWLY COMMENCED OR AGGRAVATION OF RENAL IMPAIRED PATIENTS
To prevent this worsening condition, patients renal function should be examine clearly by measuring the creatinine clearance, urine protein, urine glucose levels. Avoid the concomitant use of Ricovir EM with drugs affecting the renal functions.
IMMUNE RECONSTITUTION SYNDROME
This is most frequently occurred in anti-retroviral agents receiving patients. In this condition, Ricovir EM should be discontinued and provide a supportive measures.
LOSS OF VIROLOGICAL RESPONSE
During the combination of triple dose regimens, resistance will produced and leads to loss of activity. Monitoring the patients thoroughly while using triple dose regimen, if resistance formed or not.
SIDE EFFECTS OF TENVIR EM
Lactic acidosis & hepatic steatosis Serious exacerbation of HBV Renal damage Immune reconstitution syndrome Bone defects
Headache Insomnia Nasopharyngitis Vomiting Fatigue Depression Nausea Diarrhea Respiratory tract infection Sinusitis Rash
Increased alkaline phosphatase Increased AST & ALT Anemia Increased blood glucose Hematuria Glycosuria Increased cholesterol Elevation of serum lipase Increased creatine kinase Neutropenia
POST MARKETING EFFECTS
Renal & urinary disorders Hepatobiliary disorders Musculoskeletal disorders
Ricovir EM for PrEP is contraindicated to patients with unidentified or positive HIV-1 satus. Hypersensitivity reactions are formed if patients are contraindicated to component of Ricovir EM .
PREGNANCY & LACTATION
The pregnancy category of Ricovir EM is B Ricovir EM should be used in pregnancy period only after knowing the adverse associated with this drug. Counsel the patients about the risk benefits related to Ricovir EM , before starting the treatment
Ricovir EM container should be kept at temperature 25°C allowed between 15°C to 30°C Protect away from heat, moisture, & light
Ricovir EM is contains two drugs which is used as once daily. If patients fail to take the dose, must get advice from medical practitioner and follow the instructions